Provider Demographics
NPI:1669777975
Name:LEON, SUSAN ANGELA (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ANGELA
Last Name:LEON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:ANGELA
Other - Last Name:BLEDSOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4135 NW 18TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3524
Mailing Address - Country:US
Mailing Address - Phone:352-284-1903
Mailing Address - Fax:
Practice Address - Street 1:4135 NW 18TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3524
Practice Address - Country:US
Practice Address - Phone:352-273-5550
Practice Address - Fax:352-273-5575
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9358235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist